Dr Pranil Man Singh Pradhan
Department of Community Health Sciences, Patan Academy of Health Sciences, Lalitpur
It has been four years since the Tobacco Product Control and Regulatory Bill was passed in Nepal and significant progress has been made since then. The decision by the Nepalese government to increase the surface area of all tobacco packaging with graphic warnings against tobacco from 75% to 90% was commended globally. Despite stronger legislation, implementation has been slow. More is needed to reduce the growing burden of Non Communicable Diseases (NCDs) in the country.
Nepal has made significant progress towards tobacco control in the last decade. It became a signatory to the WHO Framework Convention on Tobacco Control (FCTC) in 2003, and ratified it in 2006. In what was regarded as the landmark in the nation’s campaign against tobacco, the Constituent Assembly approved the Tobacco Product Control and Regulatory Bill 2010 on April 11, 2011. Major features of the new law included a complete ban on smoking in public places, workplaces and public transportation. It also banned the sale of individual cigarettes, prohibited unlicensed vendors from selling tobacco products, deemed tobacco sales to minors (under 18 years of age) and pregnant women as offenses, and required tobacco companies to cover 75% of cigarette and other tobacco product packaging space with pictorial health warnings. It also introduced a health tax on tobacco products, and a total ban on tobacco advertisements, promotion and sponsorship in any form. The law supported the provision of punishments and penalties for violation of these new regulations.
Recently Nepal took another significant step by increasing the surface area of all tobacco packaging with graphic warnings to 90% of the pack. Pictorial health warnings are a particularly important deterrent against smoking among people with low literacy and younger generation. The legislation was due to be implemented by all the tobacco companies in Nepal from May 2015, and would mean Nepal has the strongest tobacco warnings after Australia, where plain packaging legislation has been in place since 2012. In recognition of this achievement, the Ministry of Health and Population of Nepal was awarded the 2015 Bloomberg Philanthropies Award for Global Tobacco Control at the 16th World Conference on Tobacco or Health held in Abu Dhabi, U.A.E. in March 2015.
However, Nepal has been lagging behind on implementation. Research in different regions of Nepal among adolescents has shown that two-thirds of adolescent smokers consume tobacco in public places such as restaurants, and nearly 75% of adolescent smoker students were found to purchase tobacco directly from shops. The majority of adolescents surveyed have seen other people smoking in public places (67.4%) and were unaware of any penalty or punishment given to them (48.8%).
The clear violations identified by these small scale studies raise the question of how effectively the anti-tobacco law is really being implemented. Another issue of concern is the rising prevalence of female tobacco use in Nepal, and the fact that Nepal has the highest female smoking prevalence among nine Southeast Asian countries.
Most high income countries have been able to combat the tobacco epidemic with strict regulations. Nepal is well on the way, aiming for a 25% reduction in the relative mortality from NCDs by 2025 (the 25 by 25 goal). Effective implementation of the anti-tobacco law is urgently needed to ensure this is achieved.